Twin pregnancy results when two eggs are fertilised or when a fertilised egg splits to form two embryos at a very early stage of pregnancy. Women carrying a twin pregnancy tend to have more severe symptoms of early pregnancy. During the course of pregnancy, they are at higher risk of miscarriage as well as other pregnancy complications like anaemia, high blood pressure, gestational diabetes and preterm delivery. Hence, these patients need more frequent follow-up with the specialist to monitor the babies as well as to look out for early signs of any of the above mentioned complication.Although triplets or higher order gestations may occur naturally, they are usually the result of in-vitro fertilisation. It is associated with significantly increased risk to the mother as well as to the fetuses compared to the twin pregnancy, preterm delivery being the most significant complication.Multi-fetal pregnancy reduction should be considered for the triplets and higher order gestations to improve the outcome of the survivors.
Breech presentation occurs when baby is presenting ‘bottom first'.Although it is a common finding earlier in pregnancy, only 3-5 per cent of fetuses are still breech at term. It is more likely in presence of multiple pregnancies, any structural defect in the baby or in the uterus or in those with low lying placenta.As vaginal breech delivery is associated with increased risk of injury to the baby, the current practice is to try and turn the baby while it is still inside the womb. This procedure is called external cephalic version and is carried out around 36-37 weeks of gestation.If the procedure is unsuccessful or if the patient does not wish to try it, the recommended mode of delivery is by Caesarean section.